The BHRC brain week lecture series concluded on Wednesday 16th of March with a seminar from the Dunedin concussion team. Over an hour and a half Julian O'Hagan, Christine Livesey, Shona Maxwell, and Glenda Wallace explained what a concussion is, why it's a problem, and what they do to help people through it.
Concussion is the result of force on the brain. This can either be direct, from a hit to the head, or indirect, from sudden acceleration and deceleration. Your brain is very soft, and made from billions of tiny cells all meshed together. When these cells are moved around by force they can be damaged. The force stretches the axons, the part that allows communication with other cells, reducing their flexibility and increasing their risk of tearing. The thinner an axon is the more likely it is to be broken. This stretching also lets certain chemicals out of the cell, stopping it from being able to communicate until it sucks all of those chemicals back up. This causes an energy crisis in your brain, and while your brain recovers from the damage the person with the concussion will experience a number of uncomfortable symptoms.
Most people will recover within 1-2 weeks, but around 10-15% of people with concussion with take longer to recover. This is usually the case with children and adolescents who, for reasons unknown, are affected much more strongly by concussion than adults.
While they're recovering, people may experience emotional, physical, or cognitive problems. They could become anxious, feel physically weak, or have trouble concentrating. Sleep disturbances are also very common.
The good news is that these problems should resolve after two weeks, and the problems aren't cumulative unless they happen one after another. Glenda, a neuropsychologist on the team, explained that if a person is completely symptom free for three months then the brain will have had enough time to heal itself and the concussion can be treated as a standalone injury.
Glenda explains to us why sleep is such an important factor in healing after concussion. She explains that in those very deep stages of sleep the cells of the brain shrink very slightly and the waste products which build up between them are flushed away. The brain cleans itself while we sleep. After concussion people can find it difficult to achieve those very deep stages of sleep, or may find it hard to sleep at all. This just makes healing more difficult. The brain is already spending a huge amount of energy trying to fix damaged cells and restore itself, but now it is having to deal with a new problem. How does she help people with these issues? By teaching sleep hygiene, and no that doesn't mean showering before bed. It is a series of strategies for getting the brain ready for sleep, giving it signals that sleep will be happening soon so that it can prepare itself.
The work of the concussion team revolves around this theme of relearning your old life. Relearning how to sleep, how to work, how to make a cup of tea. Not because the skill has been forgotten, but because the brain is healing and it cannot work as hard as it used to. People find this incredibly difficult because the damage is invisible, they look fine and so they expect themselves to perform like their old selves. But powering through a concussion is like continuing to run on a broken leg, it keeps the wound from healing.
Julian and Chris work to identify the problems caused by the concussion, while Shona and Glenda teach people how to deal with their new limitations. They stress that these limitations do not have to last forever, they are just a bandage to let the brain heal. One of the main treatments that they come back to again and again are rest breaks. These aren't sitting back and reading a book, these are moments where you sit without bright lights, or sound, and just have complete break from any stimulation. A rest break reduces the amount of information your brain has to process, and gives it time to catch up so that you have the energy to keep on going. “For some people,” Shona explained, “these rests can be every couple of minutes. It just depends on how bad your injury is.”
It's not just thinking that can strain your brain after concussion, it's moving as well. Your brain controls everything in your body, absolutely everything. If you go for a walk it controls every muscle in your body, makes sure your legs are going at the same speed, and checks your balance constantly. The more you push yourself, mentally or physically, after concussion the harder it will be to recover.
So, what does this mean? No thinking or moving for two weeks? Well, no, of course not. Each member of the concussion team is clear on the fact that they want people to be out living their lives, but what we need to learn is to be kind to ourselves. People get down on themselves on bad days, and push too hard on good days. In an increasingly fast paced world a head injury forces you to slow down, to take a break, and then keep going. It can be a hugely frustrating time, but that is why the team are there, to help.
If you or someone you know has residual effects of concussion ask your doctor to refer you to the concussion team. You don't have to accept disruptive symptoms as a normal part of your life. The earlier you start the easier it will be to get back to your old self.
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